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目的分析严重肥胖伴呼吸衰竭患者机械通气时发病情况和呼吸支持情况,探究其死亡危险因素。方法回顾分析2007年10月—2011年10月我院收治的严重肥胖伴急性呼吸衰竭且需呼吸机机械通气23例临床资料,按出院时是否存活分成生存组和死亡组,就其发病高危因素及治疗情况进行统计学分析。结果两组基础疾病构成情况比较差异无统计学意义(P>0.05);死亡组体重和体重指数(BMI)显著高于生存组,差异有统计学意义(P<0.05)。两组气管插管率比较差异有统计学意义(P<0.05),而无创支持条件和住院时间比较差异无统计学意义(P>0.05)。无创通气2 h后生存组二氧化碳分压(PaCO2)和pH值与通气前比较差异有统计学意义(P<0.05,P<0.01),氧分压(PaO2)与通气前比较差异无统计学意义(P>0.05);死亡组PaO2、PaCO2和pH值与通气前比较差异均无统计学意义(P>0.05)。结论严重肥胖患者出现呼吸衰竭行机械通气时,体重和BMI越高死亡风险越大,无创通气2 h后PaCO2和pH值改善不明显则预后不佳,且此类患者需谨慎气管插管。
Objective To analyze the incidence and respiratory support of patients with severe obesity and respiratory failure during mechanical ventilation and explore the risk factors of death. Methods A retrospective analysis of 23 cases of severe obesity with acute respiratory failure admitted to our hospital from October 2007 to October 2011 with ventilator mechanical ventilation was divided into survival group and death group according to whether they were discharged from hospital or not and their risk factors And treatment for statistical analysis. Results There was no significant difference in the basic disease constitution between the two groups (P> 0.05). The body weight and body mass index (BMI) in the death group were significantly higher than those in the survival group (P <0.05). There were significant differences in tracheal intubation rates between the two groups (P <0.05), but there was no significant difference between the two groups (P> 0.05). After 2 hours of non-invasive ventilation, PaCO2 and pH values in survival group were significantly different from those before ventilation (P <0.05, P <0.01), while there was no significant difference in PaO2 between before and after ventilation (P> 0.05). There was no significant difference in PaO2, PaCO2 and pH value between the death group and before ventilation (P> 0.05). Conclusions In patients with severe obesity, respiratory failure occurs when mechanical ventilation is performed. The higher the risk of death, the higher the body weight and BMI. The improvement of PaCO2 and pH value after 2 h of noninvasive ventilation is not obvious, and the prognosis is poor. Such patients should be cautious of tracheal intubation.